ACM™ CERTIFICATION LOGIN

ACM Examination Application

If you are requesting a retest, you must first log into your ACM account by clicking here.

NOTE: All initial examinations must be scheduled and confirmed for a date within three (3) months following approval of this application.

Upon submission, candidates will receive a scheduling notice from the testing provide, PSI/AMP, and will be directed to schedule their examination through the AMP Candidate Services online portal, or by contacting PSI/AMP by phone or email.

Referred By?

Were you referred to get certified by a member, chapter, or partner company? If so, enter their name or referral code below.

Candidate Information

*First Name:

Middle Initial:

*Last Name:

Credentials:

*Title:

*Department:

*Organization:

Business Contact Information

Please ensure you provide complete business contact information.

*Address:

*City:

*State:

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*Zip:

*County:

*Country:

*Phone:

Extension:

Fax:

*Email:

Home Contact Information

Please ensure you provide complete home contact information.

*Address:

*City:

*State:

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Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Virgin Islands

Washington

Washington D.C.

West Virginia

Wisconsin

Wyoming

*Zip:

*County:

*Country:

*Mobile Phone:

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*Home Phone:

Fax:

*Email:

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ACM RELATED CORRESPONDENCE

BUSINESSADDRESS

HOMEADDRESS

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ELIGIBILITY INFORMATION

The examination is available to registered nurses and social workers. However, there are specific eligibility requirements necessary to take the examination. These requirements include a blend of education, paid work experience* and professional practice:

I am a Registered Nurse (RN), and I possess a valid and current nursing license that is in good standing. I have at least one (1) year**, or 2,080 hours, of supervised, paid work experience employed as a case manager or in a role that falls within the Scope of Services and Standards of Practice of a case manager, by a Health Care Delivery System.

License #:

State:

Exp Date:

I am a Social Worker (SW) and I have a Bachelor’s or Master’s degree from an accredited school of Social Work, OR I have a valid social work license that is in good standing. I have at least one (1) year**, 2,080 hours, of supervised, paid work experience employed as a case manager, or in a role that falls within the Scope of Services and Standard of Practice of a case manager, by a Health Care Delivery System.

If Case Management Experience is less than 2 years provide supervisor information.

Supervisor’s Name:

Supervisor’s Phone Number:

Supervisor’s Email Address:

* Paid or unpaid internship experience does not count toward work experience.

** Candidates with less than 2 years of experience must provide supervisor contact information and an attestation that they have at least one (1) year of supervised case management experience on the ACM™ application. The National Board for Case Management (NBCM) recognizes that because of case management experience, supervision and education, some case managers may be qualified to sit for the exam after only one year of experience.

*** If an applicant meets the eligibility requirements of both an RN and SW, they must indicate which exam they wish to take and provide the applicable documentation of eligibility.

Payment Information

Current Total Transaction:

Examination Fee: $325.00

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Applicant Declaration

I hereby declare that all information contained in this application and all documentation submitted with or in support of the application is true. I
understand and agree that any misrepresentation of said facts will result in automatic disqualification to sit for the examination or revocation of the
certification obtained. I acknowledge that I have reviewed and understand the information contained in the most current Candidate Handbook available online at www.acmaweb.org/acm and that I am familiar with the principles of the Accredited Case Manager (ACM™) Code of Conduct. I acknowledge that my name, city and state of residence and
certification status are not considered confidential and may be published by ACMA. All other personal information will remain confidential.